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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 5 | Issue 1
Page Nos. 1-57

Online since Thursday, February 8, 2018

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GUEST EDITORIAL  

Kal, aaj, aur kal (yesterday, today, and tomorrow) p. 1
Puneet Batra
DOI:10.4103/jclpca.jclpca_3_18  
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COMMENTARY Top

Sociocultural beliefs and perceptions about cleft lip-palate and their implications in the management, outcome, and rehabilitation p. 4
SS Shirol
DOI:10.4103/jclpca.jclpca_41_17  
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ORIGINAL ARTICLE Top

Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study p. 6
Khushboo Ratnani, Pallavi Daigavane, Sunita Shrivastav, Ranjit Kamble, Kunal Babbar, Shivani Deshmukh
DOI:10.4103/jclpca.jclpca_50_17  
Background: This retrospective cephalometric study was designed to clarify the influence of the timing of surgical repair of cleft and its effect on mandibular growth and its position in the cleft patients which is questionable. Aim: The aim of the study was to assess the effect of timing of palate repair on the mandibular spatial position and morphology in relation to cranial base and maxilla in patients born with unilateral cleft lip and palate (UCLP) using Lateral Cephalograms. Material and Methods: This study was carried out on 20 surgically treated UCLP patients within the age group of 8–16 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 10 and late palatal repair n = 10) according to their age at which initial hard palate repair was performed. Results: Stage of palatal repair had a significant effect on the Y-axis (P- 0.045) but there is no significant difference in the spatial position, size and morphology of mandible when compared in relation to anterior cranial base and in relation to maxilla. Conclusion: Timing of surgical repair of palate has no detrimental effects on the position and morphology of mandible in patients with unilateral cleft lip and palate.
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COMMENTARY Top

Evaluation and comparison between effects of early and late palatoplasty on the mandibular morphology and spatial position with respect to the cranial base and maxilla: A two-dimensional retrospective study p. 11
N Madhumitha
DOI:10.4103/jclpca.jclpca_99_17  
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ORIGINAL ARTICLES Top

Use of metacognitive strategies in the speech and language intervention of Marathi speaking individuals with cleft of lip and/or palate Highly accessed article p. 13
Sonakshi Rajesh Rawal, Anjali Ravindra Kant, SanaZeb AbdulKadir Sheikh, Dhanshree Rajesh Gunjawate, Ashka Bhagyesh Thakar, Bharati V Khandekar
DOI:10.4103/jclpca.jclpca_86_17  
Introduction: Compensatory Articulation Disorder (CAD) is frequently seen in individuals with Cleft of lip and Palate (CLP). Speech intervention with metacognitive strategies in these individuals requires a long period of time. Objective: To study the use of metacognitive strategies in therapeutic intervention of individuals with Cleft of Lip and Palate. Methodology: 14 Marathi speaking Children with CLP between 4 to 6 years of age were evaluated for language and articulation. 7 Speech Language Pathologists devised Percentage Correct Consonants on the Photo Articulation Test for Articulation pre and post intervention. Language measures were compared pre and post therapy on the Receptive Expressive Emergent Language Scale. Results: There was a significant difference between articulation and language measures pre and post intervention respectively which is attributed to the use of metacognition strategies. Conclusion: Severity of CAD and effectiveness of strategies used for correcting articulation errors are linked to one another. Assessment of CAD and therapy scaffolding metacognition strategies can be used in Speech treatment of individuals with CLP.
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The distribution of orofacial clefts at the medunsa oral health centre, cleft clinic p. 20
Prashantha Moodley, Mosimane Peter Silas Sethusa, Mohamed Imran Khan
DOI:10.4103/jclpca.jclpca_33_17  
Background and Objectives: The prevalence of orofacial clefts shows considerable international variation. African studies show a low prevalence of these congenital malformations and this could be due to poor record keeping and a lack of data capturing. The aim of this study was to create an electronic database and to perform an epidemiological survey of all orofacial clefts seen at the MOHC, Cleft Clinic from its inception in 2003 to December 2014. Materials and Methods: Records of 383 patients were obtained and data transferred into Microsoft Access. Gender, ethnicity, site of cleft lip, and palate, as well as a family history of cleft lip and palate were recorded. Data analysis was primarily of a descriptive nature and categorical data was summarized by frequency counts and percentage calculations. Results: Forty seven percent of patients presented with unilateral clefts, 23% presented with bilateral, and 30% presented with clefts of the palate. Clefts on the left side accounted for 56.4% and on the right side 43.58%, thus making clefts on the left side more common. Clefts affecting the lip and palate accounted for 45.8%, those affecting the lip 24.2% and those affecting only the palate 30%. The most common cleft was a bilateral complete cleft and it was found in 15.3% of females and 16.78% of males. Facial clefts were found in 2.4% of patients. A positive family history of orofacial clefts was found in 5.48% with cousins being the most affected. Black patients accounted for 94.52% of those affected. Females were more affected than males, and in both genders the most common cleft identified was that of a bilateral complete cleft. Conclusion: An electronic epidemiological database of orofacial clefts at the MOHC has been recorded.
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Z-Plasty technique using a large C-flap to maximize symmetry of Cupid´s bow and minimize scar in unilateral cleft lip repair p. 28
Sanjay Naran, Renata Maricevich, Lorelei Grunwaldt
DOI:10.4103/jclpca.jclpca_42_17  
Purpose: Gaining symmetry of Cupid's bow can be challenging in cleft lip repair. We describe a technique that utilizes a modified rotation-advancement type repair to gain maximum length and to minimize scar. Methods: A retrospective chart review of unilateral cleft lip repairs performed by a single surgeon between 2010 and 2014, with at least 6 months of postoperative follow-up, Pre-, intra-, and post-operative photographs were reviewed. Patients included were those who had undergone unilateral cleft lip repair using a Z-plasty type rotation of the C-flap. Postoperative photographs were analyzed for overall symmetry of Cupid's bow and scar appearance using a 5-point visual analog scale (VAS) performed by five independent evaluators. Results: Twenty-three patients were analyzed. On VAS assessment by five independent observers, 22 out of 23 patients (96%) had good, very good, or excellent symmetry of Cupid's bow. All patients (100%) had good, very good, or excellent scar appearance. Twenty-two out of 23 patients (96%) had good, very good, or excellent overall appearance of the repaired lip. Conclusion: Z-Plasty with a very large C-flap as the method for the rotation flap in unilateral cleft lip repair is a useful technique for leveling Cupid's bow and for attaining scars that are nearly imperceptible. Further work will include longer-term follow-up, will look at the severity of the preoperative cleft, and will compare this to postoperative appearance of the lip (symmetry of Cupid's bow and scar).
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Maxillary protraction by reverse headgear treatment in patients with unilateral cleft lip and palate: A cephalometric evaluation p. 32
Sapna Singla, Ashok Utreja, Satinder Pal Singh, Sunjay Suri
DOI:10.4103/jclpca.jclpca_36_17  
Objective: This investigation was undertaken with the primary aim of evaluating the effects of reverse headgear therapy in patients with unilateral cleft lip and palate (UCLP) using lateral cephalograms and to compare the results of the reverse headgear treatment in these patients with other patients with UCLP who did not receive any orthopedic/orthodontic treatment. Materials and Methods: The treated group comprised 17 patients (13 male, 4 female; mean age 9.28 ± 2.78 years) with repaired complete UCLP and untreated group consisted of 5 subjects (4 male, 1 female; mean age 8.25 ± 2.25 years) with repaired complete UCLP. All patients in treated group received maxillary protraction with a Delaire type reverse headgear along with a customized intraoral splint worn for 16–18 h daily with force in the range of 420–480 g. Subjects in the untreated group did not receive any orthopedic/orthodontic treatment. Average treatment/observation period was 11.62 months for the treated and 12.40 months for the untreated group. Changes were evaluated at the end of the treatment and observation period by comparing pre- and post-lateral cephalograms. Results: Treatment effects of reverse headgear therapy were significant for anterior positioning of maxilla, clockwise rotation of mandible, proclination of upper incisors, and forward movement of upper molars as shown by cephalometric analysis. The untreated group did not show any significant changes, for the same measurements. Conclusions: Reverse headgear treatment is an effective method of improving the maxillomandibular relationship in patients with UCLP.
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Pellerin's craniofacial distractor: A boon in low-resource setting p. 40
Sunil Richardson, Phillipe Pellerin, Rakshit Khandeparker, Shreya Krishna
DOI:10.4103/jclpca.jclpca_61_17  
Aim: The aim is to show the use of a novel Pellerin's distractor in the correction of midfacial and mandibular deformities. Materials and Methods: A total of ten patients were included in the study. Among the ten patients, two presented with Apert syndrome, three with Crouzon syndrome (CS), three with hemifacial microsomia, one with temporomandibular joint ankylosis, and one presented with Pfeiffer syndrome. All cases were treated by the Pellerin's distractor. All patients were followed for a minimum of 1 year. Results: Two patients were lost to follow-up. All the remaining patients achieved satisfactory correction of their deformity. The average amount of advancement achieved was 37.5 mm (32–50 mm). No serious complications were seen in any patient. Pin tract scarring was the most common complication seen in six of the patients. Conclusion: The Pellerin distractor can be used in both the midface and the mandible for correction of the deformities. The device is constructed using easily available hardware that is also resusable. This makes it a cost effective alternative to the currently available distractor appliances, especially for a low-resource setting.
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CASE REPORTS Top

A rare case of median cleft of lower lip in Goldenhar syndrome p. 45
Khai Luen Koh, M Abd Latib
DOI:10.4103/jclpca.jclpca_108_17  
Median cleft on the lower lip (Tessier 30 cleft) is extremely rare with <100 cases reported in literature. Association with other craniofacial anomalies is known to occur, but some combination is extremely rare. We report a unique case of Tessier 30 cleft in a child with constellations of craniofacial cleft associated with Goldenhar syndrome. Rare facial clefts combinations reinforce the embryological basis that they are likely to result from disruption in migration of neural crest cells from rhombomeres to branchial arches rather than other simplistic theories. Case presented is distinct which will contribute to the current literature on rare craniofacial clefts syndrome.
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Bilateral coronoid hyperplasia causing limited mouth opening: A report of two cases p. 48
Pooja Jain, Supriya Balchim Gabhale, Sonali Kadam, Prakhar Agrawal
DOI:10.4103/jclpca.jclpca_101_17  
Bilateral hyperplasia of the coronoid process of the mandible is an unusual entity which often presents with limited mouth opening. Thorough clinical and radiographic examination can help in the diagnosis and the treatment planning of this condition. This article consists of a case report of two patients. The patient in each case, presented with a reduced mouth opening, and when subjected to further investigations, was diagnosed with bilateral coronoid hyperplasia.
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Moustache restoration using follicular unit extraction technique for esthetic repair of prolabial alopecia in adult male patients with repaired bilateral cleft lip: An initial report in eight patients p. 52
Sunil Richardson, Rakshit Khandeparker, Shreya Krishna
DOI:10.4103/jclpca.jclpca_63_17  
Prolabial alopecia is an inherent feature of bilateral cleft lip cases, occurring in varying degrees which is worsened following cleft lip repair. In the Southeast Asian population, a strong healthy moustache is considered a symbol of pride and hence many patients seek treatment of their alopetic prolabium due to the cleft lip. The alopetic prolabium also adds to the patients dented confidence by adding to the typical cleft lip look. Among the two techniques mentioned in the literature for hair restoration, namely, follicular unit extraction (FUE) and follicular unit transplantation techniques, the FUE technique offers a minimally invasive and virtually scar less option and is often preferred by most of the patients as well as the surgeons. A very few studies have focused on moustache restoration in adult male patients presenting with prolabial alopecia following bilateral cleft lip repair. This article presents the initial report in 8 adult male patients presenting with prolabial alopecia after repaired bilateral cleft lip that underwent moustache restoration using the FUE technique of hair restoration.
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Incomplete cleft palate in a child with De Barsy syndrome p. 56
Devi Prasad Mohapatra, Sireesha Reddy Konda, Preethitha Babu
DOI:10.4103/jclpca.jclpca_95_17  
De Barsy syndrome, a rare genetic disorder, is characterized by progeroid features, cutis laxa, ocular abnormalities, growth retardation, and intellectual disability. We present a case of 1½- year-old male child with De Barsy syndrome associated with incomplete cleft palate.
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